As a family physician I see many patients that complain of pain in their heel.. My first question is, "Is the pain worse with the first few steps in the morning and then again when you first get up and walk after sitting a while?" What causes this pain? How is it treated?



The bottom surface of the foot is called the plantar surface of the foot. Fascia refers to a strong fibrous band of tissue, similar to a ligament. The term "itis" means inflammation. For example appendicitis is inflammation of the appendix, fasciitis is inflammation of the fascia.

The plantar fascia connects the heel to the base of all five toes. The plantar fascia is also called “the spring ligament" because it acts like a spring and is responsible for maintaining the height of the arch of your foot. As you take a step, the plantar fascia allows the arch to rotate toward the floor (pronate) and flatten out a bit. Pronation, unlocks all the bones of the mid-foot. With the bones of the mid-foot unlocked, the foot can act like “a bag-of-bones" and adapt to different surfaces such as the beach, golf course, uphill, etc. At the end of the step the foot supinates (soup-in-ates), rotates away from the floor (the opposite motion of pronation) and becomes rigid again so that a forceful push-off can be achieved to propel you forward.

The plantar fascia becomes painful and inflamed if the foot pronates or rolls over too much and stretches out the plantar fascia too much.. This excessive stretching causes pain where the plantar fascia is attached to the heel. The plantar fascia actually starts to pull away from the bone and this is what causes the pain. The body responds to this by adding more bone where the plantar fascia attaches to the heel. The resulting build-up of bone is called a heel spur. Some people that have a heel spur think that the heel spur itself is causing the pain but often this is not the case. On an xray the heel spur looks like a sharp knob of bone on the heel. Sometimes the doctor will recommend surgery to remove the heel spur but this is rarely necessary. Actually many people have heel spurs on x-ray but have little or no heel pain. The heel pain associated with plantar fasciitis comes from the tearing away of the fascia from the bone and not the heel spur itself.

Why is the pain worse first thing in the morning or when you get up after sitting for a while? The human body is a rapid healer. As you are resting or sleeping the damaged attachment between the plantar fascia and the heel begins to repair itself. However, when you get up and start walking again you tear away the newly repaired attachment and this causes severe pain.

The first thing we need to do when treating plantar fasciitis is help the body repair the area where the heels attaches to the plantar fascia. Next we need to correct the problem that caused the plantar fasciitis in the first place.

To reduce the inflammation you should start taking some type of anti-inflammatory medication. Acetaminophen may help reduce the pain but it does not reduce inflammation. Doctors will often suggest and prescribe a splint that is worn at night (called a dorsal night splint). The idea is to use the splint to hold the foot slightly flexed up toward your head as you sleep. This allows the plantar fascia to heal in a stretched out position. By allowing the fascia to heal in the stretched position, the newly repaired tissue will not be injuried when you start to walk again.

As the plantar fascia begins healing it is essential that the problem which caused the heel pain is fixed. Excessive stretching of the plantar fascia due to over-pronation is the most frequent cause of plantar fasciitis. The excessive pronation can be corrected with an arch support. The over-the-counter cushioning devices are helpful to reduce the pain, help calm things down a bit and allow the healing to start. However in order to prevent the heel pain from returning you have to correct the faulty biomechanics. This usually requires a custom made arch support. Custom arch supports will be made to match the exact contour of your foot. The custom arch support will limit the pronation, reduce stretch on the plantar fascia, reduce the heel pain, allow the heel to heal and prevent the problem from recurring.

For more information please visit Exercises to Relieve Heel Pain

http://www.heelpainfree.com/2/relieve-foot-pain-with-simple-exercises